Dear Henry,
From what I read, the P and S patients (from the BPS model) can be divided
into three groups:
1. The patients with a (clear) secondary gain. This can, but does not have
to, be financial, since sick leave can offer a welcome break from the job;
3. The patients that in fact have psychological/social problems, but present
themselves with physical problems, because they do not know how to handle,
or seek help for, a PS problem (in the psychiatry this is called a
conversion syndrome).
3. The patients that suffer from hypochondria. Of the total number of
patients that visit the family practitioner every day, up to 10% seems to
have this. Hopefully the FPs filter out those patients before they refer to
us, but I guess they cannot/will not recognise them all.
What groups 1 and 2 have in common, is that they exaggerate the pain and the
disability, sometimes to a great extent.
This does not mean that B problems cannot cause PS problems. On the
contrary, I'd agree with you and Kevin.
In my opinion, this however is the biggest challenge for the medical sector
in general for the years to come: how does one find out which caused which
in this particular patient? Obviously we do not yet have
instruments/methods that have been proven sufficiently reliable and valid,
AND that do not take too much time in practice.
And of course for us, as B therapists, the challenge is to find/develop
effective methods to deal with B problems. This also means however that we
will stumble upon the so-called "illness believes" of the patients. If e.g.
a patient with a (not too advanced) knee osteoarthritis problem has always
thought that s/he has a worn-out knee, that requires rest to heal, in stead
of a (healthy) training program, problems will arise when we suggest s/he
starts riding a bike again, or a home-trainer, or gradually starts taking up
safe sports such as jogging.
I think we should be trained in that, both with respect to knowledge of the
underlying causes, as well as with respect to communication skills. (That's
where, I think, our PS training should focus on, and stop at the same time,
when it comes to treatment; other patients should be referred back or
further to a PS therapist or seen back after a litigation process has been
concluded.)
Where fibromyalgia should be shared under? I got some ideas, but I don't
know. I've seen them with obvious PS problems, but whether those were
coincidental, cause or consequence was very difficult to determine. The
literature reports conflicting evidence. A combination of causes, still B or
PS because some studies were of poor methodological quality, or inconclusive
at this point? I'll leave that to the systematic literature reviewers.
R.,
Frank
----- Original Message -----
From: "Henry Tsao" <[log in to unmask]>
To: <[log in to unmask]>
Sent: woensdag 15 augustus 2001 0:49
Subject: Re: what is wrong with psychogenic pain??
Scott and Kevin,
I don't think we are qualified to diagnose psychosocial problems, but we
should be able to recognize these factors that may impede the patient's
recovery. I agree when Kevin states that "I believe that each can cause the
other and differentiation is tremendously difficult." However, psychogenic
pain does not equal "bonkers in the head," and that was the point of my
post.
I remember talking to an experienced Physiotherapist who worked in a pain
clinic. He stated that Physiotherapists are in the best position for
treating chronic pain, because we already have a good sense of touch and
handling skills, we have good communication skills, good clinical reasoning
skills... all we need is to understand more on psychosocial factors and on
the processes of pain. I think this is the challenge for our profession in
the near future... how to incorporate psychosocial factors with our
treatment. How do I tell my patient who complains that "their disc pain has
not healed even after a year" that the pain may not be entirely tissue
oriented, without the person thinking "so you are saying it is all in my
mind."
Thank you for all your responses... it was interesting reading them.
Henry***
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